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US Surgeons Reconstruct Severely Damaged Esophagus Using Commercially Available Skin Tissue And Stents

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U.S. surgeons made the first successful esophageal reconstruction surgery through the use of FDA-approved skin tissue and stents. It took 11 years to make the full process of treatment and recovery, researchers says.

The findings about the first successful throat reconstruction was published in The Lancet. Surgeons from Milwaukee, Wisconsin have reported using commercially available metal stents and skin tissues to restore a severely damaged esophagus into its full thickness.

The unnamed 24-year-old man was in a car accident that caused him to become paralyzed and severely ill because of a disrupted esophagus, causing life-threatening infection and inability to swallow. In his case, esophagectomy or removal of esophagus and reconnecting it to the stomach to allow swallowing is not possible because the defect is too large to be repaired.

The medical team hypothesized that if the esophageal reconstruction is possible for animals, it can also be done to humans if the three dimensional shape of the esophagus is maintained in its natural environment while its regeneration process is on-going.

The doctors sourced commercially available and FDA-approved metal stents and skin tissues to treat the defect.

"[W]e endoscopically placed a readily available, fully covered, self-expanding, metal stent (diameter 18 mm, length 120 mm) to bridge a 5 cm full-thickness esophageal segment," said the report.

The stent was placed in the segment where the damaged was present - between the mediastinum and hypopharynx - to maintain the shape of the esophagus. An extracellular matrix, which is commercially available, was used to cover the stent. The stent was sprayed with platelet-rich adhesive gel derived from the patient's blood to stimulate growth factors for cell healing and regeneration.

The patient's sternocleidomastoid muscle was placed over the extracellular matrix and the platelet-rich adhesive gel.

The removal of stent was done 4 weeks after the date of surgery, because it needs to be replaced by another three stents to improve anchoring. However, the removal of the stent was delayed for three and a half years because of the patient's fears on having a leakage in the esophagus.

After 3.5 years, the stents were removed and the esophagus was assessed. With the use of endoscopy, ultrasonography and biopsy, the images derived from the assessment showed that the five-layered esophageal wall regenerated and scarred.

After stent removal, the full recovery of the patient's esophagus was tested. The muscles of the esophagus functions properly, propelling the water and other liquids from the esophagus going down the stomach on both standing and sitting positions.

Four years after the stent removal, the patient is already eating normally and having a maintained weight.

"This is a first in human operation and one that we undertook as a life-saving measure once we had exhausted all other options available to us and the patient," said Professor Kulwinder Dua and his colleagues at the Medical College of Wisconsin.

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